PPI & Access to Surgeries

Patient and Public Involvement (PPI) in the NHS or the Commission for Patient and Public Involvement in Health were set up in January 2003.

Web homepage - http://www.cppih.org

We were recently asked to confirm the access rights of the PPI to surgeries. Basically these are contained in “The Patients’ Forums (Functions) Regulations 2003 (SI 2124)”, which came into force 1 September 2003 and they state:

Entry and inspection of premises

PPI Forum Members may at any reasonable time enter and inspect health service premises as set out below.

NHS Trust PPI Forum Members may enter and inspect any premises owned or controlled by that Trust.

PCT PPI Forum Members may enter and inspect premises owned or controlled by:

Their associated PCT;
Local authorities in their area;
NHS trusts;
Local Health Boards (Wales);
GP and dental practices in their area;
Organisations which are providing services to the NHS including providers of pharmaceutical and ophthalmic services.

Restrictions on entry and inspection

PPI Forum Members do not have the right to enter and inspect premises where, in the opinion of the body or individual whose premises are to be inspected, patients’ safety, privacy and dignity and the ability of the health service to continue to function properly would be compromised (3.1)

All PPI Forum Members must have a written evidence of their authority before they enter any health services premises in their role as a PPI Forum Member and produce this if requested. (3.2)

Visits to premises used as residential accommodation are only permitted with the prior consent of the person living in the accommodation. (3.4)

The PPI Forum members, in exercising their rights to entry and inspection, shall have regard to the need to safeguard patients’ safety, privacy and dignity, the need not to compromise the effective provision of health services, and to any advice given to it by the Commission. (3.5)

A full copy of the legal framework is reproduced below…

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Last Updated on 11 June 2004
By John Baker Email: john@devonlmc.org

Patient and Public Involvement Forums – The legal framework

The National Health Service Reform and Health Care Professions Act 2002 set up Patient and Public Involvement Forums (PPI Forums, called Patients’ Forums in the Act) and the Commission for Patient and Public Involvement in Health (the Commission).

This set the broad arrangements and gave the Secretary of State for Health the power to make further provisions in relation to PPI Forums. These are the Statutory Instruments or Regulations. These provide the legal framework for the rights and duties of PPI Forums.

This guidance is split broadly into 3 parts. The first explains the relevant sections of the National Health Service Reform and Health Care Professions Act 2002 (sections 15-20 inclusive) before looking at the 2 sets of Regulations that supplement them i.e. The Patients’ Forums (Membership and Procedure Regulations 2003 (SI 2123) and The Patients’ Forums (Functions) Regulations 2003 (SI 2124).

In this guidance the particular section or paragraph from the Act or Regulations is set out in brackets after the explanation of the effect of the section/paragraph e.g. (2.1(b)).

The National Health Service Reform and Health Care Professions Act 2002

PPI Forums (Sections 15-19)

A PPI Forum must be established for every NHS Trust and Primary Care Trust (PCT) in England. (15.1)

The Commission will appoint Members of each PPI Forum (15.2). Membership must include:

At least one person who is a member or a representative of a voluntary organisation that represents the interests of users /patients or carers of patients (provided that the organisation does not represent carers who are employed by a statutory body); and

At lease one existing or past user of the services provided by the NHS Trust/PCT. (19.3) Please note that this requirement is supplemented by Regulation 2(3)(a) of SI 2123 which requires a majority of Members to be existing or past users of services that have been provided by the NHS Trust/PCT.

PPI Forums established for PCTs should also include:

At least one Member of each PPI Forum established for NHS Trust situated in the PCT area; and
At least one member or representative of any bodies that represent members of the public in matters relating to health in that PCT area, if it appears to the Commission that there are appropriate bodies. (19.4)

The Secretary of State has the power to make further provisions for membership of PPI Forums, and these are set out in SI 2123 (see below for details) .

Functions of PPI Forums

PPI Forums must monitor and review services provided by, or under arrangements made by, the PCT/ Trust for which it is established, provide advice, and make reports and recommendations about services to the PCT/Trust. (15.3)

In monitoring and reviewing services, PPI Forums must obtain the views of patients and their carers and report them to the PCT/Trust. In any advice or recommendations it makes, the PPI Forum must take account the views of patients and their carers. (15.4)

PPI Forums must also make available to patients and their carers advice and information about PCT/Trust services. In certain circumstances the Forum decide to provide assistance to patients and their families and carers. The Act also makes provision for PPI Forums to carry out any other functions to do with assisting patients and carers that may decided in the future by the Secretary of State. (15.3)

Additional functions of PCT PPI Forums

A PPI Forum established for PCT has additional functions:

Promoting public involvement

PCT PPI Forums also have the role of promoting the involvement of members of the public in their area in consultation and decisions, that directly or indirectly affect their health, made by Strategic Health Authorities, PCTs, NHS Trusts, other public bodies and others providing services to local people (16.3 (a)).

This includes making available advice and information to the public about such involvement. PPI Forums will also advise the NHS and other public bodies mentioned above about how they can consult the public and involve them in their decisions including, for the relevant NHS bodies, compliance with the public involvement and consultation requirements under section 11 of the Health and Social Care Act 2001 (16.3 (c)).

PCT PPI Forums will also monitor how successfully the NHS and other public bodies mentioned above achieve the public involvement set out in the above paragraph.

Providing information and advocacy

PCT PPI Forums will also:

Provide independent complaints advocacy services to people in the PCT’s area or who receive services provided by or under arrangement with the PCT(16.1 (a)).
Make available advice and information about making complaints about services to patients and their carers. (16.1 (b))
Represent the views of members of the public in the PCT area to any person or body which exercise statutory functions (including any overview and scrutiny committee) in the PCT area. (16.1 (c))

Referring concerns to others (15.5-6)

If, in the course of its work, a PPI Forum is concerned about any issues, it can refer the matter to:

The relevant Overview and Scrutiny Committee;
The Commission (15.5); or
Any other person or body that it thinks fit. (15.6)

Co-operation between PPI Forums

PPI Forums are required, in prescribed circumstances, to co-operate with each other in the exercise of their functions and to work jointly with one or more other PPI Forums. (15.7) See Regulation 2 of SI 2124 and Regulation 7 of SI 2123 (below) for more information..

Entry and Inspection of premises

The Secretary of State has the power to make Regulations to give access to a PPI Forum to premises where health services are provided (17). These powers are set out in Regulation 3 of SI 2124, (see below for details).

Annual Reports

Each year every PPI Forum must prepare an annual report outlining its activities and the arrangements it has in place for obtaining the views of patients (18.1). The report should be sent as soon as possible after 31^st March each year to:

The PCT/Trust for which the PPI Forum was established;
The Secretary of State;
The Commission
Any relevant Strategic Health Authority
Any relevant Overview and Scrutiny Committee. (18.2)

Further provision is given in Regulation 4 of SI 2124 (see below for details).

Further Regulations

The Secretary of State may make further provisions for PPI Forums by regulations about the functions, membership and powers of PPI Forums (see SI 2123 and 2124). This may include provisions relating to access to meetings and documents that correspond to Part 5A of the Local Government Act 1972. (19)

The details of these further regulations are set out below.

Commission for Patient and Public Involvement (Section 20)

The Act established the Commission as a non-departmental public body for England. The Commission has the following functions.

PPI Forums

The Commission will appoint Members of PPI Forums (15.2). They will provide advice and assistance to PPI Forums and facilitate the co-ordination of their activities. In addition they will provide support to PPI Forums.

The Commission will also set quality standards for the way that PPI Forums exercise their functions and monitor how successfully they meet them. It will make recommendations to the Secretary of State and other bodies on how PPI Forums can improve their performance against these standards.

The Commission will also review the annual reports of PPI Forums. (20.5)

Arrangements for patient and public involvement

The Commission will advise the Secretary of State and other bodies about arrangements for public involvement in matters relating to the health service in England. It will represent to the Secretary of State and other bodies the views of PPI Forums and voluntary organisations representing patients and carers on the arrangements for patient and public involvement. (20. 2 (a) and (c))

The Commission will also promote the involvement of the public in England in consultations on decisions and policies that may affect directly or indirectly their health, including decisions made by NHS bodies, other public bodies and others providing services to the public. (20.3 and 4).

Taking up issues nationally

The Commission may make recommendations to the Secretary of State or other people or bodies about any issues arising from the annual reports from PPI Forums. (20.5)

The Commission must report any concerns it has about the safety and welfare of patients where it is not satisfied that the matter is being dealt with, or about the way it is being dealt with, to whoever it considers most appropriate. This might be to professional regulatory bodies (such as the General Medical Council) or the Commission for Health Improvement or (CHAI after April 2004)

Independent Complaints Advocacy services

The Commission will advise the Secretary of State and other bodies about arrangements for the provision of independent complaints advocacy services (ICAS) in England and represent to the Secretary of State (and other bodies) the views of PPI Forums and voluntary organisations, representing patients and carers on the arrangements for ICAS.

The Commission will also set quality standards for ICAS and monitor how successfully services meet these standards and make recommendations to the Secretary of State and other bodies on how to improve these services. (20.2 (b) and (f))

Charges

The Commission can charge for the provision of advice and services (subject to prescribed limits). (20.8)

Regulations

The Secretary of State can make regulations to make further provisions in relation to the Commission. (20.9). Such regulations have indeed been made but are not within the scope of this guidance.

The Patients’ Forums (Membership and Procedures) Regulations 2003 (SI 2123)

This Statutory Instrument came into force on 1 September 2003.

Membership of PPI Forums

A PPI Forum shall have at least 7 Members. (2. (1)). In appointing Members to a PPI Forum, the Commission will ensure that:

Most Members are using or have used services provided by the NHS Trust or PCT for which the PPI Forum was established. In the case of PCT PPI Forums most Members must also live in the area of the PCT.(2.3 (a))

Members include members or representatives of voluntary organisations that represent or support patients or carers of patients (2.4)

PCT PPI Forums will have additional Members appointed by the Commission (2.4 (b)).

At least one Member of the PPI Forum established for each NHS Trust situated in the PCT area (2.4 (a)); and
At least one member or representative of any bodies that represent members of the public in matters relating to health in that PCT area, if it appears to the Commission that there are appropriate bodies. (2. 4 (b))

No one can be a Member of more than one PPI Forum, unless they are the Member of a Trust PPI Forum who is required to also be a Member of the PCT PPI Forum (in accordance with the requirement for additional Members of a PCT PPI Forums set out above). (4 (k))

Terms of office

A Member’s term of office shall be for between one and four years as agreed between the prospective Member and the Commission when they are appointed. (2.2)

If a Member serves for 8 consecutive years, there must be a gap of at least 4 years before that person can be a Member again. (4.1 (j) )

A Member can resign with immediate effect at any time during the term of membership by giving notice to the Commission (6.1).

Appointment of chairman and deputy chairman

The Members may appoint one of their number to be the chairman and another Member to be deputy chairman for such a period as they decide when they make the appointment (3.)

The chair may resign at any time by giving notice to Members and the Commission. The deputy chair may resign at any time by giving notice to the Members of the PPI Forum.

People not eligible to be Members

There are several grounds upon which individuals are excluded from being a Member. (4.) These are that the individual:

Is an employee, officer or member of the NHS Trust or PCT for which the PPI Forum is established or the Strategic Health Authority that performance manages the PCT/NHS Trust;
In the case of a PCT PPI Forum, is an employee, officer or member of an organisation from which the PCT has commissioned services;
Is a member of an executive of a local authority;
Is a member of a relevant Overview and Scrutiny Committee
Is an employee, officer member or representative the Commission or of an organisation which acts as a Forum Support Organisation to the PPI Forum or provides ICAS services.
Anyone who has been dismissed from the NHS in the last five years otherwise than by reason of redundancy,
Has been a chairman, member or director of a health service body and had the tenure of office terminated on one of the grounds set out in regulation 4.1(b) .
Has been disqualified/suspended from various NHS lists. See regulation 4.1(c) for details.

Someone who has been disqualified from being a Member because they were dismissed from the NHS can apply to the Secretary of State for removal of the disqualification two years after the date s/he was dismissed or tenure terminated (5.1) Where the Secretary of State refuses an application to remove a disqualification, no further application can be made until two years after the date of the refusal.

The disqualification from membership for a chairman, member or director of a health service body, whose disqualification from being a Member is due to their tenure of office having been terminated on one of the grounds set out in regulation 4.1(b), shall cease on the 2^nd anniversary of the termination of office (or such longer period as may have been specified on the termination). However the Secretary of State may reduce such periods of disqualification.

Termination of membership

The Commission may write to a Member to terminate his or her membership where it considers that it is not in the interests of the PPI Forum or the health service that the Member continues. (6.2)

The Commission will write to a Member to terminate his or her membership where it:

becomes aware that a Member is disqualified under the Regulation 4 of the SI 2123;(6.3 (a))
believes that a Member has failed to comply with regulation 11 of SI 2123 ( disclosure of any direct or indirect financial interest in a matter being discussed by the PPI Forum – see below for details) (6.4)

A person shall also cease to be a Member upon notification to the Commission by the person that he/she is ineligible for membership for one of the reasons set out above. (6.3(b))

Appointment of sub committees and joint committees

A PPI Forum may appoint a committee to carry out any of its functions. (7.1) Two or more PPI Forums may appoint a joint committee to carry out any of their functions. (7.2) PPI Forums can make any conditions for how the committees should work.

These committees may be made up wholly or partly by PPI Forum Members provided that:

A committee appointed by a single PPI Forum has at least two PPI Forum Members
A joint committee has at least one Member from each of the appointing PPI Forums.

Some people who may be disqualified from becoming Members of PPI Forums may sit on committees and joint committees, unless they were dismissed form the NHS within 5 years, their tenure as chairman, member or director of a health service body was terminated on one of the grounds set out in regulation 4.1 (b), or they were disqualified/suspended from various NHS lists in accordance with regulation 4.1(c).

Funding, premises, other facilities and staff

The Commission shall provide funding and arrange for support, including staff and office accommodation for each PPI Forum as it considers necessary to enable the PPI Forum to perform its functions. (8.1) Any staff provided shall be under the direction of PPI Forum Members. (8.2)

Allowances

The Commission may pay PPI Forum Members, or Members of committees, travelling and other allowances as it may determine.(8.2)

Meetings and proceedings

A PPI Forum, committee or joint committee can decide how to conduct its meetings and proceedings.(10.1)

The proceedings of a PPI Forum meeting, committee meeting or joint committee meeting shall not be invalidated by any vacancy in its membership or by any defect in a Member’s appointment.

However some meetings must be open to the public and at least 7 clear days before the meeting, notice of the meeting and what is to be discussed, must be published and issued to individual Members. This applies to PPI Forum meetings, sub committees and joint committees where the meeting is going to:

Agree the annual and other reports
Agree the reviews to be carried out in relation to, or making recommendations about, health services provided by, or under arrangements made by, the relevant NHS Trust/PCT
Agree the annual accounts
Agree how expenditure of its annual budget is to be allocated
Refer any matter to another person or body.

The above matters can only be made if a majority of Members agree. Any Member of a PPI Forum, subcommittee or joint committee may have the assistance of a carer, advocate and interpreter or other helper at meetings.(10.3, 10.6)

Declaring financial interest

If a Member has any direct or indirect financial interest in any matter and is present at a PPI Forum meeting where this is discussed s/he must disclose this interest and not take part in the discussion or vote on it. (11.1) The PPI Forum may exclude a Member from a meeting where matters where they have a financial interest are discussed (11.3) What constitutes a direct or indirect pecuniary interest is set out in regulation 11 SI 2123.

This applies to Members of PPI Forums, sub committees and joint committees.(11.8)

The Patients’ Forums (Functions) Regulations 2003 (SI 2124).

This Statutory Instrument came into force 1 September 2003

Joint exercise of functions and co-cooperation

PPI Forums will work together in the following situations: (2)

Where there are services provided by an NHS Trust to a PCT, the relevant PCT PPI Forum and the NHS Trust PPI Forum shall co-operate with each other in the exercise of the PCT PPI Forum’s functions. Where the NHS Trust provides services to more than one PCT, the NHS Trust PPI Forum and all the relevant PCT PPI Forums shall co-operate in the exercise of their functions in relation to those services.

Where PPI Forums have agreed that co-operation or joint working would assist them in the exercise of their functions or be in the interest of the health service.

PCT PPI Forums will co-operate with each other in determining how best to provide or arrange for the provision of ICAS. Where they agree that it is appropriate, two or more of them shall act jointly in providing or arranging for the provision of ICAS. (2.4)

PPI Forums must have regard for any advice given to them by the Commission in co-operation and joint working. This means that they must take into account the advice in making their decision but that advice is not actually binding.

Entry and inspection of premises

PPI Forum Members may at any reasonable time enter and inspect health service premises as set out below.

NHS Trust PPI Forum Members may enter and inspect any premises owned or controlled by that Trust.

PCT PPI Forum Members may enter and inspect premises owned or controlled by:

Their associated PCT;
Local authorities in their area;
NHS trusts;
Local Health Boards (Wales);
GP and dental practices in their area;
organisations which are providing services to the NHS including providers of pharmaceutical and ophthalmic services.

Restrictions on entry and inspection

All PPI Forum Members must have a written evidence of their authority before they enter any health services premises in their role as a PPI Forum Member and produce this if requested. (3.2)

Visits to premises used as residential accommodation are only permitted with the prior consent of the person living in the accommodation. (3.4)

Annual accounts

A PPI Forum shall prepare and keep annual accounts in respect of each financial year which give a true and fair view of any income and expenditure and cash flows of the PPI Forum for that financial year (4.1)

The accounts should be prepared in a form agreed with the Commission and included in the PPI Forum’s annual report. (4.2)

PPI Forums shall send a copy of annual accounts to the Commission no later than 31 May after the end of the financial year. The Commission will include a summary of all PPI Forums’ annual accounts in its own annual accounts. (4.3)

Obtaining information

A PPI Forum can ask in writing for any information from NHS organisations that it feels is necessary to carrying out its work. These organisations are PCTs, Strategic Health Authorities, NHS Trusts, the Commission, ICAS providers, or other PPI Forums. They must give the information promptly and no later than 20 working days after receiving the request. (5.1-2)

Information that breaches an individual’s confidentiality cannot be disclosed unless either that person’s consent is given or the information is anonymised.

Information legally prohibited from disclosure may only be disclosed if the prohibition is due to the identification of an individual and the information is subsequently anonymised.

Referrals to Overview and Scrutiny Committees

Where a PPI Forum considers that the NHS Trust or PCT for which it is established is not carrying out its duty to consult the public under Section 11 of the Health and Social Care Act 2001 or is not doing so satisfactorily, it may refer the matter to a relevant overview and scrutiny committee. (7.1) It shall not refer any matter until it has made all reasonable efforts to resolve the matter with the NHS Trust or PCT concerned and it considers its efforts have failed. (7.2)

Annual and other reports

At the consultation of each review that the PPI Forum undertakes, the PPI Forum will prepare and produce a report for the relevant NHS Trust/PCT. (8.1) The report will include:

An explanation of the methods used by the PPI Forum to obtain the views of patients and their carers on the services received; and
A list of the PPI Forum Members and, where appropriate and with their consent, of other people who have been involved in the review. (8.2)

Reports of these reviews must be made available to anybody who requests a copy. It must be sent to:

· The NHS Trust or PCT concerned;

· Any body or person that provided the services reviewed;

· The provider of any ICAS services mentioned in the report;

· The Strategic Health Authority responsible for the performance management of the NHS Trust or PCT to which the report relates;

· Any other PPI Forum which had a role in carrying out the review;

· The Commission.

The PPI Forum may request a reply from the NHS Trust or PCT on its report or recommendations. The NHS Trust/PCT will reply in writing promptly and no later than 20 working days following the request, explaining:

Any actions it intends to take, or
Why it does not intend to take any action. (8.4)

The PPI Forum may publish a copy of any reply received from the NHS Trust/PCT in whatever way it feels appropriate.

If the NHS Trust/PCT does not reply or the PPI Forum is not satisfied that approporiate action has been or will be taken following the NHS Trust/PCT’s reply, the PPI Forum can refer the matter to

· The Strategic Health Authority responsible for the performance management of the NHS trust or PCT to which the report relates;

· Any relevant Overview and Scrutiny Committee. (8.5)

A PPI Forum shall not refer a matter until it has made all reasonable efforts to resolve the matter with the NHS Trust or the PCT concerned and it considers its efforts have failed. (8.6)

A copy of the PPI Forum’s annual report shall be provided to any member of the public on request (8.8)